RectiCare vs Preparation H (2026 Comparison)
Medically reviewed by Dr. Robert William, MD · Written by Kevin Schwaner · Updated July 2026
Quick Answer
They solve different problems. RectiCare is a 5% lidocaine cream built for one job: numbing pain, at the strongest anesthetic concentration available over the counter. Preparation H’s flagship ointment contains phenylephrine, which reduces swelling but does not numb anything. If pain is your dominant symptom, RectiCare wins. If swelling and protection are the issue, Preparation H wins. If you want both jobs done, you will need two mechanisms, whether that is two products or a combination formula. Note that Preparation H also sells its own 5% lidocaine cream, which turns this into a price-and-preference decision rather than a strength decision.
| RectiCare Anorectal Cream | Preparation H Ointment (flagship) | Preparation H Max Strength w/ Lidocaine | |
|---|---|---|---|
| Active ingredient | Lidocaine 5% | Phenylephrine HCl 0.25% | Lidocaine 5% |
| Mechanism | Numbs nerve endings | Constricts blood vessels | Numbs nerve endings |
| Relieves pain | Strong, fast | Indirectly, via swelling | Strong, fast |
| Reduces swelling | No | Yes | No |
| Onset | About 5 to 10 minutes | Builds over 1 to 3 days | About 5 to 10 minutes |
| Price | About $18 to $25 | About $8 to $15 | About $12 to $18 |
| Known for | Specialist recommendations, post-procedure use | The default drugstore hemorrhoid brand | Familiar brand plus max numbing |
| Sizes / formats | Cream, wipes | Ointment, cream, gel, suppositories, wipes | Cream |
| Treats root cause | No | No | No |
Two Different Molecules, Two Different Jobs
The RectiCare vs Preparation H question usually comes from someone standing in a pharmacy aisle assuming these are two versions of the same thing. They are not, and the active ingredients tell the whole story.
Lidocaine (RectiCare) is a local anesthetic. It blocks the sodium channels that carry pain signals from nerve endings to your brain. At 5%, the maximum OTC concentration, it produces genuine numbness within about 5 to 10 minutes and lasts roughly an hour per application. It does nothing to the hemorrhoid itself. The swelling, the vessel, the tissue: unchanged. You simply stop feeling it for a while, which during a bad flare is exactly the point.
Phenylephrine (Preparation H flagship) is a vasoconstrictor. It narrows the swollen blood vessels in hemorrhoidal tissue, which reduces the swelling itself over one to three days of consistent use. It provides no numbing. The petrolatum and mineral oil base adds barrier protection that reduces irritation during bowel movements, which is its own quiet form of pain relief.
Once you frame it as numbing vs shrinking, choosing gets easy, because your dominant symptom makes the choice for you.
What Is RectiCare?
RectiCare is a focused product from Ferndale Healthcare built around lidocaine 5%, and its reputation was made in colorectal practices: it is frequently recommended by specialists for hemorrhoid pain, anal fissure discomfort, and post-procedure recovery, situations where pain control is the whole assignment.
Its strength is its focus. There is no pretense of shrinking or healing anything, just the maximum legal OTC numbing concentration in a cream that goes where it hurts. Its weaknesses are the flip side: no effect on swelling, roughly an hour of relief per application, and a price around $18 to $25 that runs high for a single-ingredient product. There is also a practical caution with any strong anesthetic: numbness can mask a problem that needs attention, so escalating pain that keeps needing lidocaine deserves a doctor visit rather than another tube.
What Is Preparation H?
Preparation H is the category’s default brand, on shelves since 1935 and stocked everywhere. The flagship ointment pairs phenylephrine HCl 0.25% with a protective petrolatum base, and the broader lineup covers nearly every symptom lane: pramoxine cream for milder pain and itch, hydrocortisone cream for inflammation and itching, suppositories for internal hemorrhoids, witch hazel wipes for cleansing.
The product that matters most for this comparison is Preparation H Maximum Strength Rapid Relief with Lidocaine. It contains the same 5% lidocaine concentration as RectiCare, usually at a lower price. Once that product entered the lineup, the RectiCare vs Preparation H question stopped being about strength and became about price, availability, and brand preference within the identical mechanism.
Which Relieves Pain Better?
Against the flagship Preparation H ointment, RectiCare wins on pain and it is not close: 5% lidocaine numbness within minutes versus a vasoconstrictor that only helps pain indirectly as swelling recedes.
Against Preparation H Maximum Strength with Lidocaine, it is a draw on mechanism. Both deliver lidocaine 5%. The tiebreakers are practical: Preparation H’s version is typically cheaper and easier to find in physical stores, while RectiCare carries the specialist-recommendation reputation and a wipes format some people prefer. A third option worth knowing about: HemRid Lidocaine Cream also delivers 5% lidocaine, priced to undercut both brand-name options.
Which Reduces Swelling Better?
Preparation H, by forfeit. RectiCare contains no vasoconstrictor and makes no swelling claims. If your hemorrhoid is more swollen than painful, more lump than fire, phenylephrine-based Preparation H is the relevant tool, and lidocaine products are the wrong aisle.
Can You Use RectiCare and Preparation H Together?
You can combine different mechanisms with care, and many people do: phenylephrine ointment for ongoing swelling control plus a lidocaine product for pain spikes. Two rules keep it sensible. First, never stack two products with the same active, so RectiCare plus Preparation H lidocaine cream is a no. Second, follow each label’s daily application limits, since lidocaine has a maximum daily exposure. When in doubt, alternate rather than layer, and ask a pharmacist.
The Layer Neither of Them Touches
Both products, and this entire aisle, work on symptoms at the surface. Lidocaine silences the pain signal. Phenylephrine deflates the swelling. Neither changes the weakened veins that produced the hemorrhoid, which is why the same flare tends to reappear months later asking for another tube.
A complete routine assigns each layer its job:
- Cleanse with medicated wipes after bowel movements
- Treat the surface: lidocaine for pain-dominant days, phenylephrine for swelling-dominant days
- Support internally with a daily oral supplement such as HemRid Max, delivering botanicals like horse chestnut and the citrus flavonoid hesperidin at doses studied for vein health
- Prevent with daily fiber so straining stops restarting the cycle
The HemRid Complete Care Bundle covers the routine in one order, including a 5% lidocaine cream for the surface layer, with a 120-day money-back guarantee.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Who Should Choose Which?
Choose RectiCare if: pain is the dominant symptom, a specialist recommended it, or you are managing post-procedure discomfort and want the product built specifically for that lane.
Choose Preparation H flagship if: swelling and irritation are the main complaints, you want barrier protection during bowel movements, or you need something from any store shelf tonight for a few dollars.
Choose a lidocaine cream on price if: you have decided 5% lidocaine is what you need. RectiCare, Preparation H Max Strength, and HemRid Lidocaine Cream share the identical active concentration; at that point you are shopping price and availability, not efficacy.
Add the internal layer if: this is not your first flare. Recurrence is the signal that surface treatment alone is not changing the pattern. See our HemRid Cream vs Preparation H and Preparation H vs Doctor Butler’s comparisons for the surrounding options.
Frequently Asked Questions
Is RectiCare stronger than Preparation H?
For pain, yes, against the flagship ointment: RectiCare’s 5% lidocaine numbs directly while phenylephrine only reduces swelling. Against Preparation H Maximum Strength with Lidocaine, they are equal in anesthetic concentration, so the decision comes down to price and preference.
Does RectiCare shrink hemorrhoids?
No. RectiCare contains only lidocaine, an anesthetic. It relieves pain but has no effect on swelling or the hemorrhoid itself. For swelling reduction, phenylephrine-based products like Preparation H ointment are the relevant option.
How fast does RectiCare work?
Lidocaine 5% typically begins numbing within 5 to 10 minutes of application, with relief lasting around an hour. Follow the label’s daily maximum, as lidocaine has application limits.
Can I use RectiCare every day?
Follow the label limits on applications per day, and treat prolonged daily need as a signal to see a doctor. Anesthetics mask symptoms, and pain that persists for weeks despite treatment deserves evaluation rather than indefinite numbing.
Is there a cheaper alternative to RectiCare?
Yes. Any 5% lidocaine anorectal cream delivers the same maximum OTC anesthetic concentration. Preparation H Maximum Strength with Lidocaine and HemRid Lidocaine Cream both typically cost less than RectiCare for the identical active strength.
Which is better for anal fissures, RectiCare or Preparation H?
RectiCare is the more common recommendation for fissure pain because numbing is usually the priority, and it is widely used post-procedure in colorectal practices. Fissures that do not improve within a few weeks should be evaluated, since prescription treatments exist specifically for chronic fissures.
Do either treat the cause of hemorrhoids?
No. Both are topical symptom relievers. The underlying issue is weakened, swollen veins, which topicals cannot reach. Fiber, hydration, avoiding straining, and oral vein support address the pattern rather than the episode.
Same max OTC strength · undercuts brand-name creams · 120-day guarantee
Sources
- FDA OTC monograph: anorectal drug products (local anesthetics, vasoconstrictors)
- ASCRS clinical practice guidelines: management of hemorrhoids
- Cochrane Database of Systematic Reviews: Phlebotonics for haemorrhoids
- RectiCare and Preparation H current product labels